Best of the Best: New Hope

Center for the Partially Sighted, Culver City, CA

BEST OF THE BEST: Pioneering organization helps patients with diabetes slow their vision loss and maintain their precious independence

BY CORRIE PELC

“There’s hope in sight” is the motto for the Center for the Partially Sighted in Culver City, CA, which helps people with low vision use and optimize the sight they still have. Dr. Tina Mac Donald believes the statement is especially true for people whose low vision is related to diabetes.

THE IDEA

The Center for the Partially Sighted was founded in 1978, and Mac Donald joined the Center as its first resident in 1992. Today, she is the center’s director of Diabetes Optometric Services and residency coordinator.

Mac Donald says the center is committed to its goals of aiding those with diabetes by helping them improve blood sugar control — thereby slowing the progression of vision loss and other complications — and providing them with tools and skills they need to regain and maintain independent self-management of their health and vision.

“Diabetic retinopathy is the leading cause of blindness among those of working age, and it doesn’t have to be that way,” she says. “With early diagnosis and treatment, the majority of that can be prevented.”

THE EXECUTION

The center’s Diabetes and Low Vision Program works with diabetic patients on ways they can manage their health to allow them to stay as independent as possible. The center provides comprehensive evaluations where a patient’s visual ability is assessed and low vision devices or glasses can be prescribed as needed.

Mobility instructors are also available to teach patients to move about safely, and independent living instructors help patients learn to self-test and self-medicate. “We also provide psychological services to enable individuals to better cope with medical problems and lifestyle changes, ” Mac Donald adds.

Mac Donald recently launched a pilot program called “Saving Sight,” pairing educational modules with comprehensive eye exams for uninsured or under-insured diabetic patients. Participants attend an initial class where they learn about possible ocular complications with diabetes, as well as what a dilated exam is and how it can help. After the class, participants get a certificate for an eye exam. After the exam, they attend a second educational class and receive a certificate for glasses. If a participant is found to have vision loss, they get rehabilitation help. All participants continue to receive support following the classes.

“Our hope is that these individuals ‘pay it forward’ and help others in their community learn about the complications of diabetes,” Mac Donald says. “The results have been very encouraging. I would like to see this program expand.”

THE RESULT

Mac Donald says the center’s low vision patient base continues to grow not only from the “graying of America” and growing rates of diabetes, but also through outreach to other health professionals and developments in new low vision devices.

“We do get a lot of referrals from optometrists and ophthalmologists,” Mac Donald says, but referrals also come through occupational therapists, psychologists, endocrinologists, other health care specialists and the center’s existing patients.

DO IT YOURSELF

Diabetes is on the rise — Mac Donald notes that current research estimates about 8 percent of the U.S. population is diabetic — so optometrists are sure to see more patients with the disease. “Because you will be working with people with diabetes, it is your obligation to know and counsel your patients,” she says.

For starters, Mac Donald suggests that ECPs perform thorough retinal evaluations on patients with diabetes. ODs should consider taking continuing education courses and investing in some low vision devices, as well as good lighting. She also advises training staff on symptoms of hypoglycemia and hyperglycemia, being a sighted guide, and how to work with visually impaired patients.

The American Optometric Association has new evidence-based guidelines for “Eye Care of the Patient with Diabetes Mellitus” posted on its website. American Diabetes Association publications are helpful, too.

Be open to working with low vision specialists in your community. The center receives patients referred from other optometrists who might perform the low vision exam themselves, but who then refer the patient for psych services and independent living skills. “Chronic conditions like diabetes require a team to support the individual, Mac Donald notes. “The best doctors know how to function as a part of a greater structure.”

Adding diabetes management to an optometric practice involves being willing to educate oneself, modify exams as necessary, work with a team, and maintain a strong desire to help the visually impaired. “Doing vision rehabilitation can be difficult some days, but (it’s) the best job (out there) — it is truly rewarding,” Mac Donald says.